Issue 137 face to face Alison Smith

F2F

Ursula meets amazing people who influence nutrition policies and practices in the UK.

FACE TO FACE Ursula meets: Ursula Arens Writer; Nutrition & Dietetics Ursula has a degree in dietetics, and currently works as a freelance nutrition writer. She has been a columnist on nutrition for more than 30 years.

If you would like to suggest a F2F (someone who is a ‘mover and shaker’ in UK nutrition) for Ursula, please contact: info@ network healthgroup. co.uk

ALISON SMITH Prescribing Support Dietitian Chair: BDA Older People Specialist Group Food Firster

We met in a pub. It was a really hot day, so I had the excuse to order a pint of cider. Alison had a lemony drink.

The three of us (Alison, myself and the barman) found we had one important thing in common: a complete disinterest in football, which was at fever pitch that week. Alison and I then found a corner to consider the topic that was becoming more and more interesting for me.

Alison is chair of the BDA Older People Specialist Group: surely a subject more important than two groups of men kicking a ball back and forth!

Alison had always known the job she wanted. But disappointing A Level results shut the door on her becoming a vet. Last minute clearing led her to Preston Polytechnic (now University of Central Lancashire), to study a combined degree in physiology and pharmacology with a nutrition option.

This sparked her interest in nutrition, which then led Alison to the twoyear postgraduate dietetics degree in Glasgow. “I really enjoyed the course and our small group of 11 dietitians-tobe became really close and supportive of each other,” said Alison. There was a slight hiccup to her student placement because she faced a period of depression, but was strongly supported when she started her clinical slot (take a bow, dietetic department of Hammersmith Hospital.) Her mother noticed a sad withdrawn person become a relaxed and happy one during this time.

Her first post in 1996 was as a basic grade community dietitian in

Cleveland. She enjoyed the variety of GP clinics, home visits and health promotion groups. A year on, she obtained a senior community dietitian post in Peterborough and had a great partnership with another community dietitian: “She was the ideas person and I was the finisher: we were perfect together,” Alison explained.

There was a constant increase in demand for nutrition support from care homes for the elderly and in 2001, Alison was asked to develop a more focused and sustained approach for this sector. “Care home staff often feel less respected and frequently criticised, but they do heroic work and really need support and reassurance from other healthcare professionals, including dietitians,” said Alison. Advising on the nutritional care of the elderly became the entire focus of the post and Alison developed many insights into markers of poor care versus good care. Most care home residents are very vulnerable and need diverse aspects of medical support, but nutrition status is often the underlying theme to poor health. In her post, Alison enjoyed the evidence of dietetic inputs: care staff were always impressed and delighted to observe the improvements to health from better diet and food intakes.

Some unhelpful confusions were due to public health messages in relation to lowering heart disease risk being misapplied to frail elderly people with poor appetites. Alison observed that foods provided were often diluted and

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F2F

The group advises on the development of national schemes to support better standards of food care for older people . . .

lacking taste and much of her focus was on how to increase intakes of energy, protein in particular.

Alison often engaged with relatives who insisted on long lists of likes and dislikes, but there were typical taste changes in some elderly with new preferences for sweet foods and desserts, or the enjoyment of stronger flavours. Alison advises, “Never forget to make friends with the cook and the caterer; they are often forgotten by medical staff, but can make all the difference.”

Increasingly, Alison worked outside dietetic department structures and within multidisciplinary teams. She really enjoyed the broader outlooks and insights from other healthcare colleagues, enjoying too, the many opportunities that were available to promote the importance of nutrition to them. During this time, she also became involved in feeding support for progressive neurological disorders and provided counselling and guidance for PEG feeding.

Not getting a promotion she had been hoping for, it was time to tear away and in 2013, she stepped into a pristine new job as a prescribing support dietitian in Buckinghamshire. This role was to scrutinise, assess and advise on GP prescriptions for nutritional products. “I knew all about feeding products of course, but had to do updates on paediatric and specialist metabolic products,” admitted Alison. GPs are all work heavy and time poor, and she has come to a greater appreciation of the need for brevity in communications with them. Her advice to dietitians is to keep requests for 10

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prescriptions brief, never more than two sides of A4, with formatted headings of what was needed and why, for how long, along with intended review plans. She observes waste when costly specialist feeding products are on constant renewed prescriptions that patients appear reluctant to decline.

She is currently doing a second new post as a prescribing support dietitian in Hemel Hempstead. She really enjoys her job (“the role I was made for”), working with other medical staff to review patterns of prescription and group data, with a view to balance provisions and optimise best practices. The Prescribing Support Dietitians Group is a sub-group of the BDA’s Older People Specialist Group and Alison strongly recommends joining (if this is your area of work).

In 2003, Alison joined the committee of the BDA Nutrition Advisory Group for the Elderly (NAGE), doing all things supporting PR and communication of their activities. Now she is Chair of the same newly named Older People Specialist Group. The group advises on the development of national schemes to support better standards of food care for older people, and Alison’s many fingers in many policy pies was rewarded when she received the BDA Ambassador of the Year Award in 2017.

When Alison turned to leave, I was very surprised to notice a huge ‘superwoman’ cape swishing around her. Amazing what you see in people, after getting to know them. Or perhaps it was just the effects of cider on a hot day.